Endoscopic Retrograde Cholangiopancreatography (ERCP) in Denver, CO
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What is an ERCP?
Colorado Gastroenterology conducts endoscopic evaluations to diagnose a range of gastrointestinal (GI) diseases and conditions in Denver, CO patients. An ERCP, or endoscopic retrograde cholangiopancreatography, is an endoscopic procedure where a long, thin, flexible tube or “scope” is placed into the oral cavity and advanced to the first portion of the small intestine, known as the duodenum. The device is fitted with a light and a camera on the end of it, which permits the practitioner to assess the inner wall of the esophagus, stomach, small intestine, the entrance to the bile duct, and the pancreatic duct. An endoscopic retrograde cholangiopancreatography/ERCP test may be performed to detect the cause of gastrointestinal symptoms, such as:
- Pain in the abdominal area
- Abnormal x-ray results
- Abnormal results from a liver test
Call Colorado Gastroenterology today to schedule a consultation with a GI physician to find out more surrounding this procedure.
What should I expect the day before my ERCP procedure?
Before your ERCP procedure, you will be given instructions from our GI doctor detailing the necessary preparation. The majority of patients can eat normally the day leading up to the test. Patients will be informed not to drink or eat after midnight except for any medications. It is very important to follow the directions administered by your physician. Further instructions regarding your medications will likely be given. In most cases, your medication regimen will be continued as normal. However, in certain cases, particularly in people taking blood thinners, (such as anti-inflammatories, aspirin, Coumadin, Plavix, and warfarin) and in diabetics, certain instructions will be discussed. Contact our team at Colorado Gastroenterology for additional information on how this procedure can help enhance your GI health.
What happens the day of the ERCP exam?
You will be asked to arrive at the endoscopy center in Denver, CO 1 – 1.5 hours before your evaluation. This time will be used to complete patient forms and prepare for the test. You will be asked to put on a medical gown. Our clinical team will place an intravenous (IV) line in your arm to allow sedation to be given. We will also connect you to equipment that will allow the physician and our team to monitor your blood pressure, heart rate, pulse, oxygen, breathing, and electrocardiogram levels during and after the ERCP.
Once in the exam room at Colorado Gastroenterology, you will then position yourself on your stomach on the table. The IV sedation will be given. Small amounts are provided at a time to help make certain that you do not have any reaction to the medication and to administer only the dosage you require individually. When compared to other endoscopic assessments, it is not uncommon for general anesthesia to be administered for an ERCP exam. When a sufficient sedation status is reached, the endoscope device will be inserted into the mouth. The scope will be slowly moved through the esophagus and down into the stomach, and small intestine to the area where the pancreatic duct and bile duct empties into the small bowel. A small amount of air is injected through the scope into the gastrointestinal (GI) tract to enhance visibility. During an ERCP exam, radiographic contrast dye is introduced into the bile and pancreatic ducts. An x-ray imaging machine is utilized to capture clear images of these structures to detect whether there are any abnormalities or irregularities. The remaining liquid in the upper gastrointestinal structures can be eliminated through the endoscope. Depending on exam findings, a number of things may be done during the course of the procedure, such as biopsies, opening the bile duct or pancreatic duct (sphincterotomy), removal of stones from the pancreatic ducts or gallstones from the bile ducts, or the placement of stents (plastic/metal tubes) into the bile or pancreatic ducts. When the procedure is complete, as much of the air and residual fluid as possible will be extracted through the endoscope device. On average, the evaluation takes around 30 – 90 minutes to complete based on the findings.
After the test is finished, you will be escorted to the recovery room to be monitored while the sedation medication begins to wane. The portion of sedation used during the exam and the patient’s response to the medication will dictate how quickly the patient wakes up, though most patients are awake enough for discharge within 45-60 minutes. You will not be allowed to drive for the rest of the day; therefore, you will need to arrange for a ride home. You will also be instructed not to work, sign important papers, or perform strenuous activities for the rest of the day. Most patients can eat and drink normally after discharge from the endoscopy unit, however, specific instructions regarding activity, eating, and medications will be given to the patient before discharge. Occasionally, patients will need to stay in the hospital overnight for monitoring.
When can I expect the results of my ERCP?
After the exam in our Denver, CO office, the doctor and/or nurse will go over the findings of the procedure with you. Most patients will not remember what they are told after the exam because of the effects of the sedation. It is recommended, if possible, to bring someone with you to whom the results can also be discussed. You will also go home with a typed report and be informed of any biopsy results usually within one week. Contact our GI specialists at Colorado Gastroenterology to schedule an appointment today.
Are there any risks with an ERCP?
In general, endoscopic retrograde cholangiopancreatography (ERCP) is a very safe procedure. Most complications are not life-threatening, however, if a complication occurs, it may require hospitalization and surgery. Prior to the exam, a consent form will be reviewed with the patient by the nursing staff. The risks will again be readdressed by the physician before the exam starts, and any questions or concerns can be discussed.
Acute pancreatitis, or inflammation of the pancreas, is the most common complication. This may occur in 5-8% of cases, though depending on the patient, the risk can be as high as 20%. Symptoms of pancreatitis include abdominal pain, nausea, vomiting, and possibly fever. Most cases are mild and require 4 or fewer days in the hospital. During the hospitalization patients usually only require IV fluids, pain, and nausea control. Rarely, however, pancreatitis can be more serious and even life-threatening.
Medication reactions associated with the sedation can occur. These can include but are not limited to allergic reactions, difficulty breathing, affects on the heart and blood pressure, and irritation of the vein used to give the medication. Bleeding can occur with biopsies or a sphincterotomy. Again, significant bleeding which might require a blood transfusion or hospitalization is very uncommon.
Perforation or puncture of the esophagus, stomach, or small intestine can occur. This may be recognized at the time of the exam, or it may not be apparent until later in the day. In most cases, a perforation will require surgery and hospitalization. This is still a very uncommon complication, even when biopsies are taken or a sphincterotomy is performed.
Finally, for a variety of reasons, in 5-10% of cases, the exam may not be able to be completed. It is very important that the patient contact the doctor’s office immediately if symptoms arise after the procedure such as worsening abdominal pain, bleeding, or fever.
Like any other test, endoscopic retrograde cholangiopancreatography (ERCP) is not perfect. There is a small, accepted risk that abnormalities including cancers can be missed at the time of the exam. It is important to continue to follow up with your doctors as instructed and inform them of any new or persistent symptoms.
Are there any alternatives to an ERCP?
To an extent, the alternatives to the exam will depend on the reason for needing to undergo the endoscopic retrograde cholangiopancreatography (ERCP) in the first place. In most cases, endoscopic retrograde cholangiopancreatography (ERCP) is the best method to evaluate and treat abnormalities in the biliary and pancreatic systems. However, an x-ray called a magnetic resonance cholangiopancreatography, percutaneous transhepatic cholangiogram (PTC), or endoscopic ultrasound (EUS) can evaluate the biliary and pancreatic ducts as well. The MRCP is only a diagnostic exam. Treatment of abnormalities will require an endoscopic retrograde cholangiopancreatography (ERCP) or surgery. The PTC or EUS do have treatment options.
For more information on the type of options you have, contact our Colorado Gastroenterology in Denver, CO to connect with a gastrointestinal physician today.
I have been going to Dr Rufner since 2014 when my pancreas blew up. Dr Rufner has been my rock ever since and helped me walk through a very rough road of multiple ERCPs (over 12), stones and major surgery. I feel like I owe my health and life to him. He is extremely knowledgeable, kind, calming and you cannot do better than Dr Rufner!